JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
HTCS COVID-19 Screening Form for HTCS Families. June 7, 2021
PARENTS/GUARDIANS:
- Please complete submit one form for before you come to school
- "YOU" refers to your child (you are answering the questions about your child(ren)
HTCS STAFF:
- Please submit one form for yourself before you come to school.
Symptom screening can be helpful to determine if you:
- may currently have an infectious illness that could impair your ability to work
- are at risk of transmitting an infectious illness to other individuals on the school site
Required weekly. Stay at home if you answer "yes" to any question.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Who is completing this form?
*
Choose
Parent/Guardian
Staff
Volunteer
Parent/Guardian or Staff LAST NAME?
*
Your answer
Parent/Guardian or Staff FIRST NAME?
*
Your answer
Parent/Guardian FULL NAME?
*
Your answer
Student(s) Full Name
*
Your answer
Building Location(s)
*
HTCS Altoona
HTCS Hollidaysburg
HTCS Middle School
Required
1. Do you have any of the following symptoms: Sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, or loss of taste?
*
Yes
No
2. Do you have a fever over 100.4 degrees?
*
Yes
No
3. Have you or anyone in your household been in close proximity to someone who has tested positive for Covid-19 or have you tested positive within the last 14 days?
*
Yes
No
This link will be closed by noon Monday.
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Holy Trinity Catholic School.
Report Abuse
Forms